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Solvay UFSD Afterschool Program Enrollment 2018-2019

Welcome to online registration for the Solvay Union Free District Building Educational Successes Together (B.E.S.T) Program 2019-20. Registration is required for each participating child once per school year.

Participant Information

For each of the agreements below, please read the terms, check the box to mark your acknowledgement, and type your name to confirm.

Parental Consent

I give my child permission to participate in the Afterschool program at the school named above.

Transportation Release

I, the parent/guardian, understand and give permission to the school named above to release my child, named above, to the individuals listed above. If for any reason my child must be picked up from the program (i.e. illness, suspension, etc.) the afterschool staff may contact any of the persons listed above as having permission to transport my child.


In the event of illness or an accident requiring immediate medical care permission is granted for emergency medical transportation and treatment. I, the parent/guardian named above, give permission to the afterschool staff to call 911 and arrange transportation of my child to/from the closest medical facility, hospital or physician’s office.

Consent to Photograph, Film, or Videotape a Student for Non-Profit Use (Educational, Public Service or Health Awareness Purposes)

I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the Student named above by the Solvay Union Free School District

I also grant to the Solvay Union Free School District the right to edit, use, and reuse said products for non-profit purposes including use in print, on the internet, and all other forms of media.

I also hereby release the Solvay Union Free School District and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

Please make a selection *
Student Data and Evaluation Consent

In order to monitor the effectiveness of the afterschool program and ensure its future success, an independent evaluator is conducting an ongoing evaluation. It is the intention of the evaluation to learn how these after-school services help students, and how they can be improved in order to meet the grant requirements.

Specifically, the Community Partners and the Evaluator, LPB Consulting asks permission to:

  • Contact your child’s school to obtain records showing his or her progress, including information about grades and citywide and statewide test scores.
  • Survey and/or interview you and your child about the afterschool program and its effects. Any information we collect will be used only to assess the after-school program and will not be made public. Participating in the evaluation will not affect your child in school in the afterschool program, or in any other way. We will not use your name or your child’s name in any report. At the end of the evaluation, we will destroy all records that include personal information. Participation in the study is completely voluntary and participants may withdraw at any time with no consequences. Please select one of the options below.

By selecting YES,  I AGREE, I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE. I have read the above information and I give permission for my child to participate in the evaluation of the afterschool program. I also consent for the evaluator and the CBO to obtain my child’s records (IEP’s, progress reports, report cards) and to interview me and my child. 

By selecting NO, I DO NOT AGREE, I DO NOT WANT MY CHILD TO PARTICIPATE. I have read the above information and I DO NOT give permission for my child to participate in the evaluation of the afterschool program.

If at any time you change your mind about this decision, you may contact us at any time.

Please make a selection *
Behavior Consent

YES, I give permission to the Afterschool Program to remove my child from the program if program rules are not followed and/or behavior becomes an issue.

Parent/Student Acknowledgement of Permissions

I have read and understand all of the Afterschool Program permissions, I reviewed them with my child and agree to abide them.